Historian: Thomas Jefferson supported `government run health care'

I see that the Rick Ungar post I flagged yesterday arguing that John Adams supported a 1798 measure similar to health reform's individual mandate is starting to get some traction on the Web. Good.

Now I've got a bit more for you along these lines. It turns out Thomas Jefferson also supported the same measure, meaning it had more support than you might have thought among the founders. Jefferson, of course, is the founder most often cited by the Obamacare-despising Tea Partyers as their intellectual and political forefather.

In case you missed Ungar's post, he pointed out that in July of 1798, Congress passed "An Act for the Relief of Sick and Disabled Seaman" --which was signed by President Adams -- authorizing the creation of a government operated system of marine hospitals and mandating that laboring merchant marine sailors pay a tax to support it. A historian I spoke to yesterday said this showed that "the post-revolutionary generation clearly thought that the national government had a role" in subsidizing "government run health care."

Some folks pushed back with a good question: Wouldn't it be expected for Adams, a leading proponent of federal power, to support this? What about founders like Jefferson who favored a weaker federal government?

Well, Jefferson did support this plan, the historian, Adam Rothman, a Georgetown University history professor who specializes in the early republic, tells me. Rothman emails:

Alexander Hamilton supported the establishment of Marine Hospitals in a 1792 Report, and it was a Federalist congress that passed the law in 1798. But Jefferson (Hamilton's strict constructionist nemesis) also supported federal marine hospitals, and along with his own Treasury Secretary, Albert Gallatin, took steps to improve them during his presidency. So I guess you could say it had bipartisan support.

As I noted here yesterday, the comparison between this 1798 measure and the individual mandate is imperfect. The 1798 act was a tax -- mandatory for all merchant marine sailors to pay if they wanted to work -- that was used to support the marine hospital system they used if they got sick or injured. But as Ezra Klein notes, this was in many ways similar to the system underlying the idea of Medicare-for-all -- they paid taxes in exchange for government run health care.

And it had the support of the Tea Party demi-God himself, Thomas Jefferson.

Now, we're going to hear all the details why it's not **exactly** the same. It compelled only some sailors, only sailing from some ports, and who knows, only some kind of medical care--or the hospitals were in Indian Territory.

Americans only get the broad strokes (to the extent they even get that). If the founding fathers voted for federal healthcare, that will be all most people will "get". That's how it works in the Court of Public Opinion.

Yes, like Medicare, not the private insurance mandate. This finding is a gem, though not that surprising, but I do wish people would use it to rebut silly tea-party lines than bolster the illiberal and reckless mandate.

This refried meme was fisked last year.
http://volokh.com/2010/04/02/an-act-for-the-relief-of-sick-and-disabled-seamen/

"This 1798 statute (5 Cong. Ch. 77, July 16, 1798, 1 Stat. 605) is currently making the blogospheric rounds as purported proof that the 2010 congressional mandate to purchase health insurance from a private company is based on long-established practice. INCORRECT.

"Sections 1 and 2 of the act impose a 20 cent per month tax on seamen’s wages, to be withheld by the employer.

"Section 3 requires that all the withheld taxes be turned over to the U.S. Treasury on a quarterly basis, and that the revenue shall be expended in the district where it was collected. The revenue shall be spent to support sick and injured seamen.

"So the Act is totally dissimilar to the Obamacare mandate. In the 1798 Act, the government imposes a tax, collects all the tax revenue, and spends the revenue as it chooses. This is a good precedent for programs in which the government imposes a tax and then spends the money on medical programs (e.g., Medicare), but it has nothing to do with mandating that individuals purchase a private product.

"Under section 4, if there is a surplus in a district, the surplus shall be spent in the construction of marine hospitals; the executive may combine the tax revenue with voluntary private donations of land or money for hospital construction. The President may also receive voluntary private donations for relief of the seamen, or for operation of the hospitals.

"Section 5 instructs the President to select the directors of the marine hospitals. The directors shall make quarterly reports to the Secretary of the Treasury. The directors will be reimbursed for expenses, but will not receive other compensation.

"Today, the 1798 Act is viewed as the beginning of the creation of the U.S. Public Health Service.

"The Act is very strong precedent for the federal government imposing taxes and dedicating the tax revenue to medical care for the taxed class. Further, the government may provide the medical care directly, or may cooperate with private individuals for the providing of that care. The 1798 Act thus shows that Medicare, while vastly broader in scope than anything from the Early Republic, is generally consistent with constitutional practice of that period.

"The Act certainly did not order seamen to purchase any form of private insurance, nor did it order them to purchase any other type of private good. The Act is a solid precedent for federal involvement in health care, and no precedent at all for a federal mandate to purchase private products."

The analogy is too strained. I used the history of the Public Health Service to argue against blanket assertions that federal intervention in health care was an invention of LBJ's, but that is as far as it goes.

ACA's individual mandate should stand unless the Supremes say otherwise and change course on the Commerce Clause. This historical fact will not be part of that argument.

Jefferson was also one of the original proponents of public education in this country. He wrote often as how it was in the government's interest to have educated citizens.

He did not get government support for it during his lifetime as public education was still a novel concept at that time. However his schools sowed the seeds for what eventually became the public education system in America.

That the right wing version of early America is so often wrong or lacking in full details should not come as a surprise to most. Even Jefferson believed in an active

Jefferson was never a "Republican" so he can hardly be called a RINO. Check your history books; Jefferson founded what became the DEMOCRATIC Party.
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Oooooooooooooh, scary. Another reason not to listen to Thomas Jefferson. He's **not** a RINO, he's a Democrat, one of those Marxist, socialist, pinko, homoloving liberals.

"And it had the support of the Tea Party demi-God himself, Thomas Jefferson."

I'm a big fan of Thomas Jefferson and TJ was a small government guy in principal, if not always in practice. "The government that governs least, governs best," versus, say, the Louisiana Purchase.

That being said, Jefferson made his own Bible out of the New Testament (sans miracles) and suggested that the constitution, and it's ratification, was "meh." and suggest afterwards that it should be torn up every generation, and redone from scratch, which is not exactly a Tea Party position.

And while Jefferson did indeed found what became the Democratic party, they contemporary Democratic party bears only a passing relationship to Jefferson's Democratic Republicans.

RainForestRising, this blog is in the OPINIONS section, so even Greg doesn't hold himself out as a true journalist -- he did more actual journalism as a reporter at that small Manhattan weekly in the 1990s than he does today -- that being said, he IS a journ-O-list.

George Washington was a true American.
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So far. Wait until he's tied to the mariners' hospital. Then he'll be another traitor to the illusions of the Tea Party.

Appreciate your further developing this from yesterday, your acknowledgment of some of the weaknesses in your analogy, and your inclusion of a more conservative (by today's standards) founder in this discussion.

I actually think that as a matter of policy, health care reform is imperfect but better than what we had. My concern is that it runs afoul of the commerce clause by regulating (or taxing) inactivity. You mentioned the Wickard case yesterday, and I think it sheds some light on the issue, but I also believe the farmers were permitted to go without wheat if they chose, rather than having to get wheat from the market. They were only told how they could obtain wheat, if they wanted wheat.

I am wondering if there is a way to tax/fine people only if they actually use health care services without insurance and are unable to pay for those services themselves (thus taxing/fining an activity rather than an inactivity).

A commenter yesterday pointed out that we would have to be willing to let a person die on the steps of a hospital if we went that route, but I'm not sure that is the case. The person would be required to pay for the services they receive or to pay a fine based on the amount of time prior to receiving services during which they did not have insurance.

If they are unable to pay the fine, I would assume they would have been unable to pay for insurance in the first place or to pay the fine as it is now, so either way we would have the same number of "free-riders."

I would also point out that the Constitutional argument advanced by myself and others, many of whom I suppose adamantly oppose federal health care reform as a matter of policy, may lead to the conclusion that a single-payer system is the only "constitutional" way of promoting universal health coverage. As many posters point out, they would have no constitutional problem if the government imposed a tax and spent the revenue on health care ala medicare.

Suddenly the left is eager and able to divine the founders' intentions, even those who weren't involved in drafting the Constitution and didn't think much of it? Suppose we should snicker, or is that the bright side of . . . inconsistency?

Greg, you originally floated this as a refutation of the constitutional objection to Obamacare. But it isn't. I hate to pull the old, "you aren't a lawyer and wouldn't understand" routine, but you and many other liberal nonlawyers just keep missing the point, over and over.

First, there is an unstated assumption here that, having been enacted within a decade of ratification, the act was ipso facto constitutional, or at least "the founders" must have thought so. That assumption might seem comfortable but isn't sound. Not to say the answer is clear as to the 1798 Act, but your assumption is faulty in general.

Second, as to the main constitutional issue itself, the 1798 Act did not involve "regulating" every person in the country in the "act" of not engaging in interstate commerce. It taxes wages of seamen to pay for care of their sick and injured. It isn't just an imperfect analogy but not one at all.

Third, you are always on slippery ground trying to extrapolate from admiralty to other areas of law. I'm no admiralty lawyer, but I'd suggest you need to consult some who have historical and constitutional perpective if you want to understand where the 1798 Act fits in. Admiralty in general involves a set of legal rules and principles different from the rest of the legal world. You will be led astray unless you account for this.

As of March 2010[update], legislators in 30 states have introduced legislation which would declare certain provisions of any proposed national health care bill to be null and void within the state; the legislation passed in Arizona, Idaho, Utah, and Virginia.[19] Such provisions include mandatory participation in such a system as well as preserving the right of a patient to pay a health care professional for treatment (and for the professional to accept it) outside of a single-payer system. Arizona's legislation passed as a proposed constitutional amendment, approved by voters in 2010.[20] On February 1, 2010, the Virginia Senate took a stand against a key provision of a proposed federal health care overhaul, passing legislation declaring that Virginia residents cannot be forced to buy health insurance. On March 17, 2010, Idaho Governor C.L. "Butch" Otter signed a bill requiring the Attorney General to sue the Federal Government if Idaho residents are required to buy health insurance.[21]

Oklahoma passed a constitutional amendment which would also declare a national healthcare bill to be null and void.

Republicans claim that people will lose jobs if businesses are forced to provide insurance. But they also claim our health care system (through our employers) is the best in the world. Those two claims just do not align. If it is the best system in the world then there has to be a way for these employees to secure affordable health care.

Republicans have had the opportunity to address the holes in the "world's best system." They did nothing and those of us who buy health insurance have been forced to carry a heavy burden to pay the costs for the uninsured. It may not be strictly identified as a tax on the insured, but it comes out of our wallet the same as one as our premiums skyrocketed over the past 10 years.

"Third, you are always on slippery ground trying to extrapolate from admiralty to other areas of law."
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As a liberal lawyer, the admirality aspect makes me not want to even wade into this debate. (Do you see what I did there?).

quarterback- you probably need to go back through some of the posts to know to which posters I was referring.

Many commenters above point out that the difference between the individual mandate and say, medicare, which they say is constitutional, is that medicare is a government expenditure made from tax revenues.

My point is that I have some serious constitutional questions about the individual mandate, and, opposed to a single payer or public option system, I can still see how that would be more in line with constitutional precedents in light of programs like medicare.

Now, we could argue over whether medicare is constitutional, but the issue seems decided. And taxing the public and spending that money on health care is exactly what medicare does, so how would expanding medicare to cover all individuals be unconstitutional?

NB- I do not advocate for that position. I simply point out that it addresses some of the constitutional concerns raised here. I could have articulated that better, I'm sure.

Ha, as a conservative lawyer, I feel the same way -- tossed on the waves of confusion.

On rare occasions when I hear or read about admiralty law, I think thoughts like, where did those people study law? Is that some strange foreign law they are talking?

I'm not sure how it it plays with the constitutional angle, but in general my admiralty layman's antennae tell me that it's always been understood that Congress has broad powers over navigable waters, seaways, ships, shipowners and sailors. From there (and probably starting there), it's probably all malpractice until the horizon. (Oops, did it again.)

The Kentucky and Virginia Resolutions (or Resolves) were political statements drafted in 1798 and 1799, in which the Kentucky and Virginia legislatures resolved not to abide by Alien and Sedition Acts.

They argued that the Acts were unconstitutional and therefore void, and in doing so, they argued for states' rights and strict constructionism of the Constitution.

They were written secretly by Vice President Thomas Jefferson and James Madison, respectively.

So, there is NO WAY JEFFERSON WOULD HAVE SUPPORTED THE EXPANSION OF FEDERAL POWERS AS YOU ARE ATTEMPTING TO LAMELY SAY.

Do I harbor realistic hope that SCOTUS will ever return to the Constitution? Not foreseeably. If they couldn't even deal with the acknowledged error of Roe without resort to sophistry about "settled expectations" and reliance interests, I doubt they'll ever see their way clear to greater courage.

But I resist whenever I can the general principle seemingly always at work that "what is ours (the left's) is ours and what is yours is negotiable." I'm just the kind to continue to stand athwart constitutional history circa 1937 a cry "Halt!" Who knows, maybe a future court will have the guts to say, okay, they got away with Medicare, but it's limited to its facts and history.

As a moderate lawyer, I also balk at comparing anything to admiralty law.

Last time a kindred subject arose, that caused right-left consternation, it was why we have to rebuild the levees in LA as a federal responsibility. but we don't have to rebuild the Third Ward.

This ACA mandate will either stand or fall on the Supremes' analysis of the limits of the Commerce Clause. I hope the US AG position is not ultimately dependent on the viability of "Wickard", which I have characterized as the commerce case law students love to hate.

quarterback- I appreciate the thoughtful response and tend to agree with it entirely. The post to which you were responding to originally, I'm sure you noted, was a post in which I was sort of playing devil's advocate with, among others, myself. I was really pointing out that conservatives should be careful about how they frame this commerce clause argument or they might wind up with something they like a whole lot less. I would like to see a more limited role for the feds and an expansion of state authority, but historical trends and SCOTUS opinions, even under the Rhenquist and Roberts courts, has tended not to limit federal authority, though this hasbn't always been true (The Lopez commerce clause case sticks out).

I try to stay away from Roe, but I do see it, also, as overreaching. I actually think abortion rights should be a state issue.

Back to the current-day, Mike Huckabee today said that if he announces another run for the Presidency, it would be closer to 6-7 months before the election. That seems too late in my book. He talked about candidates declaring as early now because of pressure from media and he wants to go against that. Chris Cillizza had a good article weighing Huckabee run this morning. Gov. Huckabee also spoke about the fair tax. It was pretty interesting.

I made the point yesterday that simply having the "backing" of some of our founders didn't mean that the scheme was constitutional. I don't believe that the idea was ever litigated.

Clearly there was need, even then, to decide the constitutionality of laws. When was Marbury, after all?

the reed to which Mr Sargent clings is obvious: if people way back then (like more than a 100 years ago, and, and, and they like spoke in an english sooo different from ours that you just can't barely understand it!) supported a scheme wherein the Federal government extracted money from target groups and then used that money for some specific purpose, then we must, of course, support Obamacare.

this is nonsense on its face.

As I noted yesterday Adams was there at the founding, yet he signed the Alien and Sedition acts. Does Mr Sargent think those are constitutional?

Sadly it seems that the stench of desperation has settled in on PL. We're getting a steady stream of thin reeds now, from polls to historical "analogies". What will be next? Will we be told that Obamacare is just fine because Albus Dumpledore said so?

the reed to which Mr Sargent clings is obvious: if people way back then (like more than a 100 years ago, and, and, and they like spoke in an english sooo different from ours that you just can't barely understand it!) supported a scheme wherein the Federal government extracted money from target groups and then used that money for some specific purpose, then we must, of course, support Obamacare.

this is nonsense on its face.
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You're right, your interpretation of Greg's point is nonsense on its face.

I simply do not get this debate. Can there be any doubt that folks in the 18th and early 19th Century who inhabited our land were perhaps more "socialistic" and less "individualistic" than we wish to believe nowdays. Remember the good old fashioned barn raisings? How about citizens combining for wagon trains West...bottom line early Americans got it...United we stand divided we fall...21st century Americans...not so much. Although I see enough pockets of resistance to the..you're a liberal..eff you...you're a conservative..you effing selfish pig...to have hope. But again I took a Yoga class this morning and our teacher is a saint. At the beginning and end of our practice she always points out we are honoring ourselves with this practice so that we may be able to be of service to our fellow man. What? You mean we should think of how to serve our fellow man instead of how to dominate him?
Skin him of as much money as we possibly can? I doubt my Yoga teacher is a "real" American.

Massachusetts and Hawaii also demonstrated that compulsory health insurance ultimately requires government bureaucrats (rather than medical professionals) to control nearly all aspects of individual health care and medical practice decisions.

Rather than making health insurance compulsory, Congress should make it more affordable by letting individuals control their earnings and choose their own health plan from any state in the Union.

For that reason, Judge Henry E. Hudson agreed last month with the Commonwealth of Virginia claim that requiring people to purchase health care is beyond the power of Congress, in accordance with the Constitutional Commerce Clause, or General Welfare Clause.

Next time you take yoga, avoid the Leftist reflex to cranial-anial inversion.

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